© by IAAF
19:4; 47-54, 2004
Microstretching –
a new recovery and regeneration technique
By Nikos Apostolopoulos
The focus of elite sports is on
intense training and elevated com-
petition, resulting in record-break-
ing performances, all of which
expose the athlete’s body to strains
and stresses exceeding its inherent
adaptive capacity. If training, skill
acquisition and competition exceed
ABSTRACT
the adaptive capabilities of the
body, the result is trauma, a condi-
tion defined by the author as Exer-
cise Induced Injury Response Syn-
drome (EIIRS). If the magnitude of
the syndrome becomes chronic it
may develop into a pathological
disorder. Microstretching is a re-
covery-regeneration technique
directed towards the restoration of
normal structure and function of
the musculoskeletal system. It
works in synthesis with the body
diminishing and eliminating the
effects of EIIRS, providing the
coach, athlete and sports medicine
professional with a new technique
aiding the recovery-regeneration
process. The obvious advantage is
decreased trauma enabling the
athlete to recover and regenerate
the musculoskeletal system and
maximise performance and
longevity.
New Studies in Athletics • no. 4/2004
Introduction
uscular adaptation to physical
M stress is significant for normal func-
tion and development. The need for
proper recovery during and after training is
paramount for a successful increase in the
level of fitness. The ability to increase and/or
Nikos Apostolopoulos is the direc-
tor of the Serapis Stretch Therapy
Clinic in Vancouver, British
AUTHOR
Columbia, Canada and the
founder of Stretch Therapy® and
Microstretching®. He graduated
from the Faculty of Physical and
Health Education at the Universi-
ty of Toronto with an emphasis in
Sports Medicine. He is a member
of the American Association of
Anatomists (AAA), American
Association of Clinical
Anatomists (AACA), American
College of Sports Medicine
(ACSM) and the International
Association for the Study of Pain
(IASP).
maximise performance depends on a balance
between “physical exertion” and “recovery”. If
an athlete’s daily training produces an imbal-
ance between the two parameters, he/she is
likely to produce symptoms of over-training,
but more importantly, it will cause micro-
trauma to the musculoskeletal system. The
increased demands on the human body to
perform at higher levels, can be defined as a
form of musculoskeletal stress; the pathogen-
esis being an increased intensity and func-
tional load and a decrease in recovery pre-,
intra-, inter-, and post-exercise.
The inability to recover quickly inevitably
produces acute muscular symptoms such as
47
 Microstretching – a new recovery and regeneration technique
sprains and strains and both are a direct
assault on the musculoskeletal tissue. Micro-
traumatic responses will stimulate an inflam-
matory response. This response has been
defined as Exercise Induced Injury Response
Syndrome (EIIRS), referring to localised dam-
age to muscle fibre membranes and contrac-
tile elements. The inflammatory response may
be a result of a single forceful mechanical
event such as lifting, catching or jerking dur-
ing a maximal lift or an accumulated strain
associated with less forceful but repetitive
loading of the musculoskeletal structure.
During exercise, two types of pain sensa-
tions are generated: Temporary Pain (TP) and
Delayed Onset Muscle Soreness (DOMS). Tem-
porary pain is an accumulation of a metabol-
ic by-product (i.e. lactic acid) and fully dissi-
pates with the proper implementation of a
work / rest ratio during sets and post training.
After training, a low impact aerobic activity
such as walking or cycling will continue blood
circulation and flush out the accumulated
lactic acid.
A false assumption is that lactic acid is
responsible for muscle soreness two or three
days post intense workout. Blood and muscle
lactate levels typically return to normal values
after 30 to 60 minutes of recovery. The micro-
trauma to the connective tissues caused by
EIIRS is responsible for this soreness as a result
of microscopic tears of the muscle tissue.
EIIRS is a determinant of DOMS. The symp-
toms usually appear a couple of hours to a day
post strenuous training, peak between one
and three days and disappear within five to
seven days. It has been suggested that strenu-
ous muscular work can trigger the initiation of
an inflammatory cascade, characterised by a
series of cellular and humoral changes quali-
tatively similar to, but quantitatively different
from trauma and sepsis (Shepherd and Shek,
1998). Muscle damage is indicated by ultra-
structural and morphological changes, as
denoted by an increase and presence of intra-
muscular neutrophils and cytokines. The neu-
trophil infiltration persists for up to five days
(Fielding et al. 1993). Its influx serves to clear
damaged tissue in preparation for repair and
48
cell growth, the proliferation and remodeling
phases of an inflammatory response.
Recovery of the muscle tissue depends on
the intensity and duration of the athlete’s
exercise programme and the type of exercise.
Eccentric exercises, a forced contraction dur-
ing lengthening, causes the greatest damage
to the connective tissue with extreme sore-
ness post exercise and training. A possible
explanation may be that fewer fibres are
recruited to handle a given load, resulting in
excessive mechanical strain on the fibres
(Clarkson et al. 1992). Other studies have
reported an increase in cytokines from high
intensity long duration exercises exceeding
75% of an athlete’s aerobic capacity for a
duration of two hours (Bury et al. 1995).
The regulatory activity of EIIRS is important
to correct departures from the normal course
of the health of the connective tissue. Unlike
severe trauma and sepsis, which can be life
threatening, EIIRS is sub-clinical, resulting in
the removal of damaged cells and the subse-
quent re-growth of connective tissue by
increasing collagen production. The distur-
bances affecting the function of the muscu-
loskeletal system can be classified as either
acute or chronic. EIIRS–acute is a response
defined as an equilibrium between physical
exertion and recovery. The individual recovers
fully and the connective tissue adapts to a
new training level resulting in an increase in
performance. The collagen that is deposited
produces weak fibrils with random orienta-
tion. With maturity the collagen during the
remodeling phase becomes oriented in line
with local stresses (Doillon et al. 1985). How-
ever, EIIRS–chronic is interpreted as an imbal-
ance where the process of physical exertion
New Studies in Athletics • no. 4/2004
overrides the recovery process. The muscu-
loskeletal system is in constant flux and is not
given the opportunity to adapt to the new
physical demands. It is only with proper rest
and recovery that the individual will resolve
this imbalance.
The athlete’s response to a physical demand
on their body is to adapt both quantitatively
 Microstretching – a new recovery and regeneration technique
and qualitatively. The vital response is an
inherent protective adaptive mechanism
whose outcome is to establish a new or main-
tain an old level of function. Many therapeu-
tic techniques as well as the manipulation of
the training parameters (intensity, frequency
and duration) have been designed to work
synergistically with this adaptive mechanism.
The recovery processes work to restore dam-
aged tissue as a direct adaptation to a normal
function.
Microstretching
Introduction
Microstretching is a recovery - regenera-
tion technique directed towards the restora-
tion of normal structure and function. It aims
to restore the integrity of the connective tis-
sue thereby increasing its load handling abil-
ity. It is important for a recovery technique to
conform to the healing process of the body
meshing with the appropriate activities of the
regeneration period. If the technique is
aggressive and the musculoskeletal tissue is
inflamed, athletes will find themselves in a
perpetual recovery– inflammatory phase not
fully progressing and improving performance.
It has been suggested that for the proper
function of the musculoskeletal system there
needs to be a constant ratio between the
force of muscular contraction and resistance
of the tendon. The musculo-tendinous unit
can be considered the interface of adaptation
to different locomotor needs. This site is very
important in cushioning abrupt and violent
motor stimuli. Conditions such as muscle
fatigue and weakness diminish the contractile
ability of the muscle predisposing the muscu-
lo-tendon unit to a strain injury (Ippolito et
New Studies in Athletics • no. 4/2004
al. 1986).
The tensile strengths of the relative con-
nective tissues provide clues as to the inten-
sity level of the stretching exercises, pre-
venting the potential onset of an inflamma-
tory response. Muscle has a tensile strength
of 77lbs/in2 (5.41 kg/cm2) while tendons have
a tensile strength of 8,700 to 18,000lbs/in2
(604.64 to 1264.53 kg/cm2 (Hollinshead et
al. 1981). At the muscle laboratory of Duke
University, researchers found that cyclic
stretching equivalent to 50% of the maximal
force needed to produce failure resulted in a
significant increase in the length of muscle
stretched at failure (László et al. 1997). Even
though the study was conducted on animals,
it indicated the importance of light intensity
stretching and its ability to increase length
and decrease the likelihood of injury to mus-
cle.
The dynamic forces (tension, compression,
shearing, rotation, and bending) and how the
structure functions under these forces, pro-
vides the stages and steps of physical causa-
tion of the reaction of the connective tissue.
These forces are present during training,
directing and controlling the response of the
musculoskeletal system. The response of the
body to the effect of these dynamic forces
can and will produce changes that are less-
ened by microstretching, imparting a quality
of resiliency to the whole structure.
Microstretching benefits the athlete beyond
simply aiding in the recovery of the contrac-
tile system. This restoration helps to raise the
threshold to EIIRS by increasing the response
of the self-regulating mechanisms associated
with restoring the motor system. Structuro-
functional unity helps the athlete to increase
their physical loads and sustain longer and
harder training sessions with minimal damage
to the connective tissue.
The athlete’s primary concern is the execu-
tion of movement – a dynamic equilibrium
between structure and function. Micro-
stretching provides simple guidelines effec-
tive for increasing performance and decreas-
ing the potential of trauma to the body. Dur-
ing the recovery phase from workouts, the
athlete needs to incorporate a proper recov-
ery-regeneration programme, one that
becomes habitual, correcting any slight mor-
pho-functional shifts.
The key to proper stretch-recovery pre– and
post-training lies in the tensile strength of
49
 Microstretching – a new recovery and regeneration technique
the tissues as indicated above. The discrepan-
cy of the tensile strength between the muscle
and the tendon suggests that during an
extreme stretch, a micro tear will occur pri-
marily in the muscle section of the musculo-
tendon junction. If the connective tissue has
already been traumatised due to EIIRS it is
counterproductive to continue the trauma by
introducing a recovery technique that elicits
pain causing potential muscle fatigue and
weakness.
The design of a proper recovery programme
using microstretching takes into considera-
tion the intensity, frequency, and duration of
the stretch and the principle of Stability, Bal-
ance and Control (SBC®). When training is
done properly and the integrity of the con-
nective tissue is maintained, the recovery
process is enhanced with the development of
a “flexibility reserve”. This refers to the devel-
opment and storage of an increased range of
motion in the musculoskeletal system,
enhancing performance, allowing movement
to be executed without excessive tension,
decreasing the resistance of the extended
muscles and serves as a prophylaxis to injury
and diminishes the onset of EIIRS.
Microstretching may exceed other forms of
flexibility (ballistic, active assisted and propri-
oceptive neuromuscular facilitation) with
regards to recovery by diminishing the onset
of EIIRS.
Microstretching decreases muscle tension
thereby increasing circulation and neural
conductivity. Dr. Robert Salter, who developed
Continuous Passive Motion (CPM), has shown
the importance of passive motion as a thera-
peutic modality following trauma to the con-
nective tissue. Salter hypothesized that a
gentle passive motion technique would accel-
erate the healing of articular cartilage and
peri-articular structures, such as the joint
capsule, ligaments and tendons (Salter 1989)
Even though his emphasis was post–operative
patient care, the effects of trauma and
inflammation can become inhibitors to reha-
bilitation. Early passive non-painful recovery
can assist connective tissue to heal in an
acceptable manner, resulting in the typical
50
parallel arrangement of collagen and elastin
fibres (Ibid).
The emphasis in this section has been to
establish the positive influence of gentle
forces on the recovery of the musculoskele-
tal tissue after intense training and repeti-
tive loading. The implementation of this
knowledge and its influence on the training
parameters (intensity, frequency and dura-
tion) provides the athlete and coach with
the tools to develop a proper recovery pro-
gramme aimed at preventing injury, increas-
ing performance and years of participation
at a high level.
Intensity
Microstretching is always executed at a
low intensity level (approximately 30 – 40
percent of a maximal perceived exertion).
This value is less than that indicated earlier
with regards to the Duke University Muscle
lab. This level increases the pliancy of the
connective tissue, specifically the tendons
and the ligaments. Similar to micro–injuries
the influence of microstretching is manifest-
ed at the cellular level. Unlike a strain, it
results in a minimal activation of the spe-
cialised receptor tissues of the muscle and
tendon (the muscle spindle fibres and the
Golgi tendon organ). The muscle spindle
senses muscle lengthening while the Golgi
tendon organ senses tension.
Microstretching helps damaged tissue to
recover and regenerate, and aids in the
realignment and the potential breakdown of
scar tissue. As scar tissue is laid down and
ages, there is a tendency for compression to
occur. Developed compression predisposes the
injured area to a greater level of strain. If an
New Studies in Athletics • no. 4/2004
athlete performs an aggressive stretch they
will activate the specialised receptor tissues.
However, microstretching may bypass these
receptor tissues, further enhancing the
process of recovery and regeneration.
It is critical while stretching, to avoid strain
and pain. Pain will activate the sympathetic
nervous system, increasing muscle tone prim-
 Microstretching – a new recovery and regeneration technique
ing the body for activity. This insult on the tis-
sue will cause EIIRS developing and perpetu-
ating a recovery – inflammation loop, rein-
forcing and maintaining an injured state.
Using low intensity stretching or
microstretching, an athlete will recover from
this loop, decreasing the muscle tone affect-
ed by the connective tissue (i.e. fascia), regen-
erate connective tissue and help to establish
order when the collagen is being laid down
during tissue regeneration.
Frequency
In “Periodization” Bompa, (1999), suggests
that in order for athletes to improve their
flexibility they need to stretch at least twice
per day. In addition, each muscle group needs
to be stretched at least three times per ses-
sion. Repetition is vitally important. Learning
movements and improvement of skills, both in
infancy and adulthood, are dependent upon
repetition. Repeated stimulation of the cen-
tral nervous system integrates the new phys-
ical pattern, turning it into an automatic
response.
The ongoing development of flexibility
increases the elasticity in the tendons and
muscles, increasing the sensitivity of the joint
receptors. This aids in the processing of infor-
mation, enabling the athlete to sense the sig-
nificance of a physical stimulus and in turn
affect a suitable motor response.
The habitual development of flexibility and
the increase in muscle length will enable the
athlete to recover faster post workout.
DeVries, in his electromyography study, indi-
cated the delay in the onset of muscular
New Studies in Athletics • no. 4/2004
fatigue (DeVries and Adams 1972), and the
prevention and alleviation of muscle sore-
ness after exercise (DeVries 1961). With an
increase in the functional range of motion
there is a reduction in the incidence and
severity of injury (Taylor et al. 1990). In
short, the frequency of flexibility training
helps to foster an increase in the threshold
of EIIRS.
Duration
The optimal length to hold a stretch is
approximately 60 seconds. On average for a
stretch to progress from the middle of the
muscle belly to the tendons, it takes 30 sec-
onds. A token 10 – 15 second stretch may be
beneficial to the muscle, but it has minimal
influence on the ligaments and tendons,
largely responsible for range of motion and
flexibility.
A recent physiotherapy study in the United
States, looking at the effect of duration of
stretching of the hamstring muscle in an eld-
erly population, concluded that a 60 second
passive stretch produced the greatest
increase in rate of gains with respect to range
of motion (ROM). At the conclusion of the
three month study, the group introduced to a
60 second stretch had an increase in degree
gains of 2.4 per week as compared to a 30
second stretch and a 15 second stretch whose
gains where 1.3 and 0.6 degrees per week
respectively (Feland et al. 2001).
At the Serapis Stretch Therapy Clinic, clini-
cal observations indicated that a stretch held
greater than 60 seconds resulted in patients
feeling tighter. The Golgi tendon organ may
be the cause for this phenomenon. Prolonged,
low intensity stretching of a muscle may
cause the muscle to lengthen slightly beyond
its normal resting length. Even though the
intensity of the stretch was low, dampening
the stretch reflex, the sensation of tension
though light was still registered by the neuro-
muscular system. This stretch was sufficient
to trigger a response from the Golgi tendon
organ. This increase in tightness might have a
direct effect on the connective tissue perpet-
uating EIIRS.
Sequential changes in the function of
muscle will affect performance. A defining
quality of an athlete is the maturation and
coordination of the musculoskeletal system,
a tempero-spatial development defined by
the maturation of the neuromuscular sys-
tem. It is suggested that specific behaviour
and physical functions are associated with
51
 Microstretching – a new recovery and regeneration technique
definite anatomical structures of the nerv-
ous system (McGraw 1989). During recovery,
there is an important need to place the body
in a position conducive to relaxing the nerv-
ous system and eliminating the potential for
muscle contraction. This state refers to the
principle of Stability Balance and Control
(SBC).
Trauma to the musculoskeletal system may
stimulate the sympathetic nervous system
(SNS) and its subsequent responses. This is
not independent of sympathetic function
(Blumberg et al. 1997). It is important to
relax the nervous system for the constant
activation of the SNS may lead to clinical
conditions defined as sympathetically main-
tained pain (SMP) (ibid). SMP may be
responsible for the development and main-
tenance of chronic pain experienced by ath-
letes. This pain is exemplified by a response
termed protective adaptation (PA), the
adjustment of the musculoskeletal system to
diminish and prevent the sensation of pain.
PA is a by-product of EIIRS and its develop-
ment occurs over many years of exposing the
body to trauma and intense training without
proper recovery. The cycle is a progressive
physiological regulation of movement
defined as an extensive decrease of the
range of motion about a joint(s). This regu-
lation changes the movement behaviour of
the body, restricting the ability of the mus-
cle to accelerate through a full ROM. The
restriction to the connective tissue con-
cerned with the proper execution of move-
ment ultimately results in a decrease in ath-
letic performance and longevity within the
athlete’s sport of choice.
Application of Microstretching
Lack of flexibility hampers the development
of motor skills. The increase of speed is
adversely affected since the athletes will
accelerate their limbs over too short of a dis-
tance. Insufficient flexibility affects the motor
efficiency of endurance sports. This decrease
in range of motion translates into an
increased strength effort requiring greater
energy.
52
The natural ability to increase performance
is through the proper implementation of a
recovery-regeneration programme. This will
ensure a synchronised nerve-muscle connec-
tion, fostering the subsequent development of
an instinctive response to an athlete’s envi-
ronment(s). This response confers a unique
quality on the muscle’s related motor axon(s).
The modulated neuron will, in turn, effect and
determine new structural and/or functional
relations, defining and, in turn, being defined
by new muscle patterns that are both flexible
and dynamic with a high degree of structural
order.
Repetition is the means by which athletes
learn the patterns specific to their sport. If an
athlete has had an injury or a growth spurt
and stretching exercises are not prescribed
specifically to increase range of motion about
the joint(s) it will result in an altered pattern
of muscle use, affecting proper skill acquisi-
tion. The successful handling of training and
the treatment of an injury will impart a con-
viction to the athlete to continue flexibility
training.
Flexibility develops a natural continuity of
exercises, a rhythmical function of the main
muscle groups, as well as the ease of regulat-
ing the loads of training (intensity, volume
and frequency). Coordination is fully
enhanced and developed through the proper
development of flexibility. The athlete’s coor-
dination is determined by the repertoire of
skills.
When training for either explosive or
endurance events the training for the devel-
opment of the flexibility system is the same.
The changes imposed on the function of the
New Studies in Athletics • no. 4/2004
musculoskeletal system are a derivative of a
developmental structural change. For
instance if the angle of the joint movement is
compromised due to a structural change, as a
result of an injury or repetitive strain, this will
impede the maximal development of motor
control, a function of the neural system. The
neural system is important because it gathers
and processes information with a subsequent
 Microstretching – a new recovery and regeneration technique
motor action. Flexibility training helps to fos-
ter an adaptive physical response, aiding in
the production of a harmonious and econom-
ic function of movement.
A true state of the integrity of the muscu-
loskeletal system is its “cold state”. This refers to
connective tissue whose core temperature has
not been increased due to a warmup or during
and after a physical activity. The information
relayed to the central nervous system of the
“cold state” is essential in perceiving the slight-
est strain and pain. This acts as a prophylactic
mechanism warning the athlete to spend extra
time on the issue at hand. If such a step is neg-
lected the outcome could be catastrophic.
The application of stretches following the
guidelines of microstretching offers several
advantages to athletes, circumventing the
limitations imposed on stretching routines of
the past. Many athletes will be able to re-
adjust the biological adjustments of the mus-
culoskeletal systems introduced and designed
to protect the connective tissue. This will help
to re-establish proper locomotor mechanics.
Greater compliance of the muscles, tendons
and ligaments will help the athlete to perform
with maximal force and acceleration.
The principles of microstretching were pre-
sented to athletes of various disciplines. The
learned activities were dependent upon their
background attitudes, posture, training and
previous injuries. These parameters are
responsible for the patterning of learned
physical behaviour. The athletes were moni-
tored for their tolerance to and the subse-
quent recovery from pain and discomfort. The
athletes noticed an increase to the tolerance
of pain as a result of the increase in their
New Studies in Athletics • no. 4/2004
range of motion, with a decrease in the
recovery time post activity. It is believed that
the underlying neural mechanisms are modi-
fied through proper stretching restructuring
the synapses and synchronicity of the con-
nective tissues.
Microstretching was developed to increase
the range of motion about a joint and to
address the increase of inflammation due to
training and injury. It is not prescribed as a
pre-warm up stretch routine, dynamic flexi-
bility will suffice, for it will aide in the prepa-
ration of the connective tissue. Upon cessa-
tion of training, it is important to allow the
body to cool down. Therefore, microstretching
is to be performed two hours post training.
When the body has cooled down significant-
ly, one can recognise tightness and strain,
allocating more time to proper stretching in
order to prevent injury and the potential for
the development of chronic musculoskeletal
disorder.
In summary, the increase in flexibility as a
result of microstretching, will be beneficial
for the development of the track and field
athlete. This increase in range of motion is the
common denominator, with the specific
demands of the sport determining its use.
Conclusion
The musculoskeletal system and the behav-
iour correlated with its function and develop-
ment are a complex and dynamic organisa-
tion. When the training is intense the tenden-
cy is for the connective tissue to be trauma-
tised, resulting in an injury defined as Exercise
Induced Injury Response Syndrome (EIIRS).
The effectiveness of the body is measured in
its ability to overcome this trauma, repairing
itself and adapting to a new level of training.
This unique evolution is enhanced by the
implementation of a proper recovery–regen-
eration programme designed to accelerate
the healing process in between training.
Unlike conventional methods that produce
pain, microstretching is relevant to the heal-
ing process by depressing the response of the
sympathetic nervous system and dampening
the muscle spindles and Golgi tendon organ
ameliorating the inflammatory response.
Clinical experience attained at the Serapis
Stretch Therapy Clinic, has resulted in the
development of the microstretching guide-
lines. Implementation of these guidelines in a
clinical setting results in the athlete’s ability
to train at greater loads and volume increas-
ing their performance level.
53
 Microstretching – a new recovery and regeneration technique
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